Loo CK, Mitchell PB. A review of the efficacy of transcranial magnetic stimulation (TMS) treatment for depression, and current and future strategies to optimize efficacy. J Affect Disord 88: 255-267

School of Psychiatry, University of NSW, Psychiatrist, Black Dog Institute and South Eastern Sydney Illawarra Area Health Service, Australia.
Journal of Affective Disorders (Impact Factor: 3.38). 12/2005; 88(3):255-67. DOI: 10.1016/j.jad.2005.08.001
Source: PubMed


There is a growing interest in extending the use of repetitive transcranial magnetic stimulation (rTMS) beyond research centres to the widespread clinical treatment of depression. Thus it is timely to critically review the evidence for the efficacy of rTMS as an antidepressant treatment. Factors relevant to the efficacy of rTMS are discussed along with the implications of these for the further optimization of rTMS.
Clinical trials of the efficacy of rTMS in depressed subjects are summarized and reviewed, focusing mainly on sham-controlled studies and meta-analyses published to date.
There is a fairly consistent statistical evidence for the superiority of rTMS over a sham control, though the degree of clinical improvement is not large. However, this data is derived mainly from two-week comparisons of rTMS versus sham, and evidence suggests greater efficacy with longer treatment courses. Studies so far have also varied greatly in approaches to rTMS stimulation (with respect to stimulation site, stimulus parameters etc) with little empirical evidence to inform on the relative merits of these approaches.
Only studies published in English were reviewed. Many of the studies in the literature had small sample sizes and different methodologies, making comparisons between studies difficult.
Current published studies and meta-analyses have evaluated the efficacy of rTMS as given in treatment paradigms that are almost certainly suboptimal (e.g of two weeks' duration). While the data nevertheless supports positive outcomes for rTMS, there is much scope for the further refinement and development of rTMS as an antidepressant treatment. Ongoing research is critical for optimizing the efficacy of rTMS.


Available from: Philip Bowden Mitchell
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    • "Numerous studies on the efficacy of rTMS revealed that rTMS is an effective treatment option in major depressive disorder. In most meta-analyses, rTMS is superior to sham control (Burt, Lisanby, and Sackeim, 2002; Holtzheimer, Russo, and Avery, 2001; Kozel and George, 2002; Lam, Chan, Wilkins- Ho, and Yatham, 2008; Loo and Mitchell, 2005; McNamara, Ray, Arthurs, and Boniface, 2001; Schutter, 2009). In one exception, however, Couturier (2005) reported in his metaanalysis in 2005 that there were no significant differences between rTMS and sham control (Couturier, 2005). "
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    DESCRIPTION: Transcranial magnetic stimulation (TMS) was introduced as a novel method of brain stimulation in 1985, and now it is widely used in research of cortical excitability, neuronal connectivity and plasticity, and also is applied to the treatment of various neurological and psychiatric conditions. This review is written with the purpose of introducing the brief conspectus and area of therapeutic application of TMS. The techniques, equipment and treatment modalities of TMS are continuously developing, and its area of therapeutic application is being extended. For determining the form of the optimal therapeutic application of TMS in various clinical conditions, more data from controlled studies should be obtained.
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    • "Moreover, extreme right frontal asymmetry has been associated with affective disorders such as depression (Thibodeau et al., 2006) and social anxiety disorder (SAD; Moscovitch et al., 2011). In addition, increasing left-sided activity or decreasing right-sided activity with repetitive transcranial magnetic stimulation (rTMS) resulted in improvements in depression (for review see Loo and Mitchell, 2005) and anxiety (for review see Pallanti and Bernardi, 2009) symptoms. EEG neurofeedback is another method used to modulate cortical activity. "
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    ABSTRACT: Frontal asymmetry in alpha oscillations is assumed to be associated with psychopathology and individual differences in emotional responding. Brain-activity-based feedback is a promising tool for the modulation of cortical activity. Here, we validated a neurofeedback protocol designed to change relative frontal asymmetry based on individual alpha peak frequencies (IAF), including real-time average referencing and eye-correction. Participants (N=60) were randomly assigned to a right, left, or placebo neurofeedback group. Results show a difference in trainability between groups, with a linear change in frontal alpha asymmetry over time for the right neurofeedback group during rest. Moreover, the asymmetry changes in the right group were frequency and location specific, even though trainability did not persist at one week and one month follow-ups. On the behavioral level, subjective stress on the second test day was reduced in the left and placebo neurofeedback groups, but not in the right neurofeedback group. We found individual differences in trainability that were dependent on training group, with participants in the right neurofeedback group being more likely to change their frontal asymmetry in the desired direction. Individual differences in trainability were also reflected in the ability to change frontal asymmetry during the feedback. © The Author (2015). Published by Oxford University Press. For Permissions, please email: journals.permissions@oup.com.
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    • "Therefore, TMS has been used to establish causality between brain and behavior, and also as diagnostic and therapeutic tool in several domains such as neurophysiology , neurology, neuroscience, and psychiatry. It has been used as a Food and Drug Administration approved intervention for major depression, migraine, and presurgical motor and language mapping (George et al., 2010; Loo and Mitchell, 2005; O'Reardon et al., 2007). tES is a generic term that designates several techniques based on the modality of the applied electricity, which can be direct (transcranial direct current stimulation— tDCS), random noise (transcranial random noise stimulation—tRNS), or alternating (transcranial alternating current stimulation—tACS) currents. "
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    ABSTRACT: Addiction is a chronic relapsing brain disease with significant economical and medical burden on the societies but with limited effectiveness in the available treatment options. Better understanding of the chemical, neuronal, regional, and network alterations of the brain due to drug abuse can ultimately lead to tailoring individualized and more effective interventions. To this end, employing new assessment and intervention procedures seems crucial. Noninvasive brain stimulation (NIBS) techniques including transcranial electrical and magnetic stimulations (tES and TMS) have provided promising opportunities for the addiction medicine in two main domains: (1) providing new insights into neurochemical and neural circuit changes in the human brain cortex and (2) understanding the role of different brain regions by using NIBS and modulating cognitive functions, such as drug craving, risky decision making, inhibitory control and executive functions to obtain specific treatment outcomes. In spite of preliminary positive results, there are several open questions, which need to be addressed before routine clinical utilization of NIBS techniques in addiction to medicine, such as how to account for interindividual differences, define optimal cognitive and neural targets, optimize stimulation protocols, and integrate NIBS with other therapeutic methods. Therefore, in this chapter we revise the available literature on the use of NIBS (TMS and tES) in the diagnostic, prognostic, and therapeutic aspects of the addiction medicine.
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